As Nature Made Him (26 page)

At that first meeting with me, David was nervous and guarded. He explained that his childhood had made it difficult for him to trust strangers, but later, over a beer at the Hard Rock Cafe, he grew more relaxed. He spoke about how his parents and brother had been crucial supports in a childhood that he described as “a pit of darkness.” I soon learned that a formidable sense of humor had also played a role in his survival. Describing the physical differences between himself and his heavier, slightly balding twin, he shouted over the pounding music, “I’m the young
cool
Elvis. He’s the fat
old
Elvis.”

But the strongest impression I was left with was of David’s unequivocal masculinity. His gestures, walk, attitudes, tastes, vocabulary—none of them betrayed the least hint that he had been raised as a girl. And indeed, when I asked whether he thought his extraordinary childhood had given him a special insight into women, he dismissed the question. David had apparently never been a girl—not in his mind, where it counts. He insisted that his conversion from Brenda at age fourteen marked nothing more than a superficial switch in name—as if the double mastectomy, two phalloplasties, and lifelong course of testosterone injections he needs to compensate for his castration were mere details. “I’ve changed over,” David said, “but mainly by name. The rest was all cosmetic. I just had repaired what was damaged. That’s all.”

Through the summer and fall of 1997, David’s story continued to receive media coverage. With this coverage, another set of voices in the debate over the heretofore unexamined practice of infant sex reassignment began to be heard. These were the voices of those intersexes born after the publication of Money’s 1955 protocols—people in their thirties and forties who as babies had undergone normalizing genital surgeries and sex assignments and who were now ready to speak on the record about their lives.

They had already begun to emerge as a public voice four years earlier, largely through the efforts of one person: a San Francisco–based activist named Cheryl Chase, who had been lobbying for changes in intersex treatment since the early 1990s. “I wasn’t getting very far,” admits Chase, a short-haired woman with a dry, rational manner that belies the passion driving her. “That changed overnight when the John/Joan case blew up.”

At her birth in suburban New Jersey in 1956, Chase presented a classic case of ambiguous genitalia. Instead of a penis and testicles, there was a somewhat vaginalike opening behind her urethra, and a phallic structure of a size and shape that could be described as either an enlarged clitoris (if she were assigned as a girl) or a micropenis (if a boy). After three days of deliberation, the doctors told Chase’s parents that their child should be reared as a boy. She was christened Charlie. But a year and a half later, her parents, still troubled by Charlie’s unusual appearance, consulted another team of experts. They reassigned her as a girl and told her parents that she would grow up to be a happy, healthy, normal woman. Her parents changed her name from Charlie to Cheryl, and the doctors removed her clitoris.

Like David Reimer, Chase was then raised without knowledge of her true birth status. Thus, like David, she experienced a childhood punctuated with mysterious, unexplained surgeries and regular genital and rectal exams. Also like David, she grew up confused about her sex. “I was more interested in guns and radios,” Chase says, “and if I tried to socialize with any kids, it was generally boys, and I would try to physically best my brother. I didn’t fit with boys or girls, I was stigmatized and ostracized by my peers, and picked out for teasing all the time.” At age ten, Cheryl’s parents brought her to a psychiatrist, who attempted to prepare Cheryl for her role as wife and mother. As a preadolescent, she recognized that she was erotically attracted to females.

By age nineteen, Chase had done some of her own medical sleuthing and understood that she had been subjected to a clitorectomy as a child, and she began to search for her medical history. She was thwarted by her doctors, who refused to reveal the circumstances of her birth. It took three years for her to find a physician willing to disclose her medical records. It was then that Chase read that doctors had labeled her a “true hermaphrodite”—a term that refers to people whose gonads possess both ovarian and testicular tissue. This was also when she first learned that she had spent the first eighteen months of her life as a boy named Charlie, and that her parents, doctors, aunts, uncles, grandparents, and family friends had conspired to keep this secret from her. She also learned that the operation she had undergone at age eight (to relieve “stomachaches”) had actually been to cut away the testicular part of her gonads.

Horrified and angered at the deceptions perpetrated upon her and aggrieved at the loss of her clitoris, which had rendered her incapable of orgasm, Chase began to seek out others like herself. Through letters to the editors of medical journals and magazines, news articles, listings with crisis hotlines, and ultimately on a website, she established a network of inter-sexes in cities across the country. In 1993, she dubbed the group the Intersex Society of North America, a peer support, activist, and advocacy group. By mid-1999, Chase had been contacted by nearly four hundred intersexes from around the world—many of whom told stories almost identical to her own.

To meet Chase and members of ISNA—as I did in the spring of 1997, when they held a peaceful demonstration outside Columbia Presbyterian Hospital in New York, where Chase’s clitoral amputation was performed—is to enter a world where it is impossible to think of sex with the binary boy-girl, man-woman distinction we’re accustomed to. There was Heidi Walcutt, genetically male with an XY chromosome constitution but born with a rudimentary uterus, fallopian tubes, internal sperm ducts, and a micropenis, who describes herself as a “true American patchwork quilt of gender.” There was Martha Coventry, born with an enlarged clitoris but a fully functioning female reproductive system, who is the mother of two girls. There was Kiira Triea, assigned as a boy at age two, who did not learn of her intersexuality until puberty, when she began to menstruate through her phallus. At that stage she was referred as a patient to Dr. Money at the Psychohormonal Research Unit, where she was treated from age fourteen to seventeen, in the mid-1970s, concurrent with Brenda Reimer.

Kiira and David have never met or spoken, but Kiira’s story bears striking parallels to his. She describes how Dr. Money, evidently attempting to ascertain whether she possessed a male or a female gender identity, questioned her about her sex life—in the frank language for which he is well known. “Have you ever fucked somebody?” she remembers Money asking. “Wouldn’t you like to fuck somebody?” She also describes how Money showed her a pornographic movie on a projector he kept in his office. “He wanted to know who I identified with in this movie,” she says.

Contrary to Money’s claim that an intersexual baby reared as a boy will develop an unequivocal male gender identity, Triea’s sexuality and sense of self proved to be far more complicated than that. At fourteen she agreed to undergo feminizing surgery at Johns Hopkins to simulate female genitals, but when she became sexually active for the first time at age thirty-two, her erotic orientation was toward women.

The other intersexes in Chase’s group show a similarly complex sexuality. Max Beck was first assigned and reared as a girl named Judy. Despite strong masculine thoughts, inclinations, behaviors, and attitudes, Judy tried to stick with her assignment in order to placate worried parents and relatives, even going so far as to marry in her early twenties. But at age twenty-seven Judy left the marriage and divorced. At the age of thirty-two she stopped taking estrogen, changed her name to Max, and began taking testosterone by patch. Yet even today, Max resists the simple designation of male. “I have always felt—and continue to feel myself to be—intersexed,” he recently e-mailed me. “ ‘Masculine’ is simply a more comfortable compromise, testosterone a tastier hormonal cocktail than estrogen.” Not all the intersexes who joined Chase were sex-reassigned as babies. Dr. Howard Devore, the psychologist who studied under John Money in the 1980s, was born in 1958 with acute hypospadius (a penis open from base to tip) and with undescended, underdeveloped testicles, but was raised as a boy. Beginning at age three months he endured some sixteen “normalizing” surgeries through childhood, aimed at giving him a cosmetically convincing penis. The experience, Devore says, was emotionally devastating—and wholly unnecessary. His genitals still do not resemble those of a normal male and the sole result of his constant hospitalizations is a psychological scarring far worse than he would have experienced had he been raised with counseling to accept his atypical genitals. Devore refrained from making this argument to Money. “I learned very early that if you choose to do battle with John,” he says, “you have to deal with a very, very angry man who’s going to make you feel horrible for challenging him.” (Devore says that only in the wake of the “ John/Joan” revelations has he felt emboldened to make his intersexuality public—and to openly challenge his former professor.)

Armed with her own story and those of her fellow intersexes, Chase began trying to alert the medical establishment to the dangers of the protocols for intersex management initiated by Johns Hopkins. ISNA’s stated aim was to abolish all cosmetic genital surgery on infants—not simply the castration and sex reversal of micropenis boys. While Chase did not oppose life-saving corrective surgery on genitals, she denounced as “barbaric” all medically unnecessary cosmetic treatments on newborns that could have an irreversible effect on their erotic or reproductive functioning. And ultimately, she said, she wanted to “end the idea that it’s monstrous to be different.”

Chase found it more difficult than she had anticipated to gain an audience with influential people in the field—including John Money. “I’ve written him several times, politely, asking if he would clarify his position for us,” Chase told me. “Each time he would return my letters with a note scribbled on the corner saying he doesn’t have enough time to talk to me.”

Chase also wrote to the American Academy of Pediatrics—an association with a membership of over fifty-five thousand doctors in the United States, Canada, and Latin America. The AAP has long endorsed Money’s protocols for intersex treatment. “I write to inform you that many who have been treated according to the model you outline have found that the treatment itself has rendered our lives an ordeal,” Chase wrote to the AAP in 1995. “We who are intersexual have been discussing our experiences through the Intersex Society of North America . . . and we find that the current model of treatment does nothing to discourage the shame and secrecy surrounding intersexuality. . . . We would love to open a dialog with you, and we encourage you to mention, when you teach about treatment of intersex, the existence of a vocal, organized population of intersexual former patients who oppose the current model.”

The AAP did not respond to this letter. Chase wrote to them again in 1996 and again received no response. That October, Chase and other ISNA members held a demonstration at the AAP’s national conference in Boston. Academy officials refused to meet with the protesters, but they did distribute a press release among the journalists and protestors at the demonstration. “The American Academy of Pediatrics, a voice for children for over 60 years, is aware of the concerns and sensitive to the needs of intersexuals,” the statement read. It went on to say that the AAP would not change its stance on intersex treatment and cited Money’s work from the 1950s to defend its position.

Chase also appealed to former Surgeon General Joycelyn Elders, who prior to her appointment to Clinton’s administration had practiced for over twenty years as a pediatric endocrinologist in Arkansas, where she regularly applied Money’s protocols for intersex management to ambiguously sexed newborns. Elders never acknowledged Chase’s letters.

In 1996, Chase did succeed in persuading the
New York Times
to write a feature article about the burgeoning intersex activist movement, but in the story members of the medical establishment refused to discuss ISNA’s complaints. Dr. John Gearhart, head of pediatric urology at Johns Hopkins, dismissed the group as “zealots.” In a conversation with me in the summer of 1997, amid the media storm generated by Diamond and Sigmundson’s article on the failed twins case, Gearhart was more politic when addressing the issues raised by ISNA and David’s case. While he insisted that sex reassignment remains a viable option for boys born with micropenis or who lose their penises to injury, he noted that advances in penile reconstruction made him more hesitant to recommend the procedure today. “If John/Joan happened today,” he told me, “I would sit down with those parents and say, ‘The child has testicles; it’s a normal male child.’ I would suggest that you
could
change the child’s gender, but I would not recommend that, because reconstructive genital surgery has come light-years since John/Joan’s accident.”

Gearhart also said that advances in medicine render ISNA’s concerns obsolete. “When these people in ISNA were operated on, twenty-five and thirty years ago, there weren’t really children’s reconstructive surgeons around,” he said. “So most of [these babies] had their clitoris or their penis amputated. That was wrong, OK?
That
was wrong. But the surgeons didn’t know any better. Nowadays, people in modern reconstructive surgery are not cutting off little babies’ clitorises or penises, or anything along those lines.” Gearhart said that modern microsurgery retains sensation.

To hear the back-and-forth exchanges of doctors like Gearhart and activists like Cheryl Chase is to be convinced that the issues involved will not be settled anytime soon. For instance, Chase flatly rejects Gearhart’s claim that surgeons maintain clitoral sensation after reducing the organ’s size. Gearhart meanwhile continues to reject ISNA’s call for change in the current treatment protocols, insisting that scores of intersexes live happily in the sex assigned to them in infancy and that Chase and the members of ISNA represent only the “disgruntled” few—a charge to which Chase and other ISNA members take particular exception. They insist that silence among intersexual adults does not reflect happiness with the decisions made for them as babies, but is instead a symptom of the shame and secrecy that are the legacy of the current treatment methods.